TrumpCare Is Here! Behold Its Glory As You Bask In The Warmth Of Your Hobo Trash Can Fire!

The Republican plan to repeal and replace the Affordable Care Act is finally here, and it’s designed to achieve the nation’s most important health care goals: having a plausible chance of collecting just enough Republican votes to pass, maybe. Oh, and if it does become law, millions of people will go back to being uninsured, and many of them will get sicker and die, or go bankrupt, but that’s hardly important. The main thing is fulfilling eight years of promises to repeal Obamacare, which no one likes except for roughly half of Americans. But a whole quarter of people polled do want the ACA repealed, so that’s a mandate. Let’s grab some tongs and nose plugs and see what exactly is in this shit sandwich they’re calling the “American Health Care Act.”

The Republican plan, in the form of two House bills, would keep three popular provisions of the ACA: no exclusions for preexisting conditions, no annual or lifetime caps on benefits, and children can stay on their parents’ insurance until the age of 26. Beyond that, things start getting all free-markety and grim. Our favorite Dumb Republican Talking Point is that this plan eliminates the hated mandate that everyone must buy health insurance or pay a tax penalty. And it does. Oh, but there’s a “but”: If you drop your insurance and don’t buy a new plan within 2 months, your new insurance will cost 30% more for an entire year. But it’s not a mandate!

Instead of the ACA’s subsidies for insurance plans sold on the individual market, the Republican version would offer refundable tax credits of between $2000 and $4000 a year, depending on the enrollee’s age and income. This would actually provide better financial help for one slice of the self-insured market: middle-aged people who make a bit too much to qualify for subsidies under the ACA, which doesn’t provide any subsidy for people making over $48,000 a year. So, will there be much difference between getting a subsidy and getting a tax credit? Of course there will be: lower-income people will get screwed, as God intended.

Compared with the ACA’s subsidies, the tax credits would go to more people but provide less financial help to lower-income people, according to Larry Levitt, senior vice president of the Kaiser Family Foundation.

It’s all right though. Because the House GOP is pretty sure that if you make less than $48,000 a year, you are probably just going to win the lottery anyway — at least, judging by the fact that literally ten percent of the bill deals with throwing lottery winners off Medicaid (at last! something on which we can all bipartisanly agree!).

If you’re a statistics nerd, the Kaiser Family Foundation has a more detailed look at how the proposed tax credits would stack up against the ACA’s subsidies.

Say, here’s a neat trick: the GOP plan will free insurance companies to charge older enrollees five times as much as they do younger ones, which will probably swallow up the somewhat expanded tax credits for a lot of people. The ACA only allowed insurers to charge three times as much as youngs. That means “adults ages 60 to 64 would see their annual premiums soar 22%, or nearly $3,200, to nearly $18,000,” according to a study commissioned by AARP. Hooray for individual responsibility! If you’re going to insist on aging, the costs should be on YOU.

Even Moar

Oh, and yes, there’s also the millions of people who’ll lose coverage: The plan would roll back the ACA’s expansion of Medicaid starting in 2020 (people who enrolled prior to that could keep it), but that’s OK because poor people don’t want insurance and don’t care about their health anyway. They like dying from preventable illnesses, because they’re poor — if they were smart, they’d be rich, wouldn’t they?

It would overhaul the whole program, which covers more than 70 million people, by sending states a fixed amount of money per enrollee, known as a per-capita cap. This would limit federal responsibility, shifting that burden to the states. However, since states don’t have the money to make up the difference, they would likely either reduce eligibility, curtail benefits or cut provider payments.

All this could hurt not only poor adults, but also low-income children, women, senior citizens and the disabled.

Are you sick of winning yet? Really, there’s no reason to worry about it, since by the time the biggest changes of TrumpCare go into effect, Donald Trump will have brought so many jobs back to America that everyone will be much richer anyway. Or at the very least, Trump supporters won’t really get screwed by the changes for an election cycle or two, so that works out just fine.

The winners under the new plan are people who are younger and healthier, who will be less inclined to buy into insurance pools, and will never age or need medical care in the future, because as most 20-year-olds know, if you’re young and healthy now, you stay that way forever. Also, insurance companies will have a hell of an incentive to support the GOP plan: Under the ACA, insurance companies could only deduct the first $500,000 of executives’ income as a business expense. The GOP, which at least knows how to reach out to the truly needy, removes that limit so insurers can write off their CEOs’ entire multi-million dollar compensation. Surely that will motivate them to find cost-effective solutions for all policyholders.

The only good news about this mess is that plenty of Republicans already hate it. Four GOP senators from states who’ve accepted Medicaid expansion are already opposed to that provision, while in the House, rightwing nutbars from the Freedom Caucus hate the proposal because it’s far too generous and won’t kill enough poor people isn’t a straight repeal of Obamacare that would leave health care up to the free market. So in addition to universal Democratic opposition, it seems nobody likes this mess. And we mean nobody:

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Then there’s Donald Trump, who has insisted he would never support any plan that didn’t cover everyone. Maybe he’ll come out against the House GOP plan, since it very clearly will not cover everyone. Yep, he’ll probably insist they fix that. You bet he will. That Donald Trump, he’s a man of his word, all right… Hey! LOOK! OBAMA TAPPED HIS WIRES! IMPEACH OBAMA!

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Doktor Zoom Is the pseudonym of Marty Kelley, who lives in Boise, Idaho. He acquired his nym from a fan of Silver-Age comics after being differently punctual to too many meetings. He is not a medical doctor, although he has a real PhD (in Rhetoric and Composition).
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